Birthday parties are back. So are sleepovers, pep rallies, and mask-free schools. We know that not everyone is fully embracing the change, as the relaxing of pandemic restrictions — including rolling back mask mandates and the overnight evaporation of physical distancing — can feel sudden after two years of living with COVID-19.
As pediatricians and mothers of young children, we believe that these changes are safe, even as kids under 5 await approval for a vaccine and many kids older than 5 have yet to receive it. (Moderna officials announced Wednesday that they’re seeking approval in the U.S. and Europe to authorize two small-dose shots for children under 6.) Instead of leaving children behind, the lifting of pandemic restrictions is giving children back the vital experiences that they have had to put on hold.
With our pediatric population largely split between the vaccinated and unvaccinated, many parents come to us with worries about how to reconcile the precautions we emphasized for the last two years with the newer recommendations to resume germ-filled adventures. Some have been parents only during the pandemic, when routine childhood illnesses were relatively rare, and they now need guidance in how to think about risks of infections in children who have not been sick before.
We advocate that any child eligible for vaccination get immunized with the Pfizer-BioNTech vaccine prior to resuming activities without masks or social distancing. This will protect children from severe disease and will help cocoon those who are immunocompromised or younger than 5.
It is important to acknowledge that COVID poses a serious risk to many vulnerable populations. However, we also know that most children will not experience major complications from COVID, particularly when viral prevalence is low. Throughout the pandemic, only a small percentage of all pediatric cases have been hospitalized. When many children are getting infections, that small percentage translates to a significant number of children; when the prevalence of disease is low, hospitalization and death are exceedingly rare.
We believe we now can look toward a future where COVID is endemic, when we will live with it as we do other respiratory infections, without concern of overwhelming illness or death in our communities. Kids may get mild illnesses and need to stay home from school for a few days; the rare child will require hospitalization, and pediatricians will care for these children as they do each year for RSV, influenza, and other common childhood infections. There will always be germs, whether COVID or something else, that spoil our plans. And when that happens, we need to do our part in keeping others healthy by using the habits we have developed during this pandemic — staying home when sick, washing our hands well, and considering masking when prevalence spikes.
Many pediatricians, like us, are shifting their stance on COVID precautions. But we remain concerned about unvaccinated and vulnerable children — we are simply reassessing the risk COVID currently poses and balancing that with what will best help children grow and develop. For our most vulnerable patients, we always have — and always will — ensure that they and their families understand the additional layers of protection they may need to protect themselves from COVID and all childhood illnesses. We know the opportunity to vaccinate most children will come soon, but until then, we believe the immunity of our community will protect our youngest as they begin to participate in everyday life with us.
We aren’t leaving young children behind; we are showing them a future supported by science.
Katie Lockwood is a primary care pediatrician at Children’s Hospital of Philadelphia. Lori Handy is a pediatric infectious disease specialist and medical director of infection prevention and control at Children’s Hospital of Philadelphia.